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Liver Diseases

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Canadian Liver Foundation Offers Hope to People Affected by Liver Disease

 

Don Rodgers, National Director of Communications, Canadian Liver Foundation.

What few laypeople realize is that the liver plays a crucial role in maintaining overall health. It performs numerous vital functions including the processing of dietary nutrients and vitamins, maintaining blood sugar levels, activating or detoxifying medications and manufacturing proteins. People may also be surprised to learn that liver disease is the fourth leading cause of death by disease in Canada. More than two million Canadians, regardless of age, sex, ethnic origin or lifestyle, will be affected by a liver or biliary tract disease in their lifetime. With improvements in diagnostic testing and a growing awareness of risk factors, more Canadians are finding out they have liver disease. Many liver diseases can be prevented, quite a few can be treated and early diagnosis is very important. The outlook is hopeful and research is continuing to improve the lives of people living with these disorders.

When a person is diagnosed with a liver disease, it can be a very stressful time for all concerned--patients, families and friends. Unanswered questions create anxiety, and doctors and other health care providers often are too busy to discuss every detail. Pamphlets and websites can provide a wealth of information but cannot possibly answer all of a patient's questions. Hence the role of the Canadian Liver Foundation's Living with Liver Disease Program, which provides a wide range of information about all aspects of liver disease, as well as a forum in which people can ask questions about their individual concerns.

The program provides emotional and social support through the participants' interaction with others in the same situation. Facilitated group sessions feature qualified speakers who cover issues such as nutrition, exercise, diagnosis, treatment, liver transplantation and social assistance. During each session, patients can hear valuable information from a physician or another knowledgeable health care provider caring for liver disease patients. In the course of the session, patients will have the opportunity to ask questions and chat with other people who are experiencing the same or similar challenges. The Canadian Liver Foundation offers Living with Liver Disease Programs in communities across the country. Depending upon local needs, sessions may cover one topic per month or may be compacted into an all-day seminar format.

The Canadian Liver Foundation's National 1-800 Help Line offers a confidential bilingual service to all people affected by liver disease. When people are first diagnosed with liver disease, they have many questions about their prognosis, how it will impact their lifestyle and what treatments or other interventions might be available to them. The Foundation's National 1-800 Help Line gives patients and their family members somewhere to turn for answers. For more information about a program in your area, please call the National Help Line at 1-800-563-5483 or visit our website at www.liver.ca.

Related Terms: Liver Diseases, liver disease

The Diagnosis and Management of Gallstones in the Elderly

Bao Q. Tang, MD, FRCS(C), Clinical Fellow, Minimally Invasive Surgery Program, Division of General Surgery, University Health Network, Toronto, ON.
David R. Urbach, MD, MSc, FRCS(C), Assistant Professor of Surgery and Health Policy, Management and Evaluation, University of Toronto; Staff Surgeon, Division of General Surgery, University Health Network, Toronto, ON.

Gallstone disease is common in elderly persons. The clinical syndromes caused by symptomatic gallstones include biliary colic, acute cholecystitis, acute gallstone pancreatitis, choledocholithiasis, cholangitis and gallstone ileus. In most cases, an accurate diagnosis can be made on the basis of the history, physical examination, basic blood tests and abdominal ultrasonography. Cholecystectomy is the appropriate treatment for most patients with symptomatic gallstones, and can be done safely in the elderly. Because the risk of complications of gallstone diseases is higher in the elderly than in younger patients, symptomatic gallstone disease should be identified and treated promptly in elderly persons.
Key words: gallstones, cholecystitis, pancreatitis, cholangitis, cholecystectomy.

Related Terms: Liver Diseases, cholangitis, cholecystectomy, cholecystitis, gallstones, pancreatitis

A Review of Acute Viral Hepatitis in the Elderly

 

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of the Elderly, Toronto, ON.

Viral hepatitis is a major cause of acute and chronic liver disease worldwide. This article will review the epidemiology, etiology, presentation, diagnosis, management and prevention of acute viral hepatitis (Types A, B and C), with specific reference to the elderly population. Both similarities and differences between management in the elderly and the general population will be detailed. A cost-effective approach to diagnosis will also be formulated.
Key words: hepatitis A, hepatitis B, hepatitis C, acute viral hepatitis, elderly.

Related Terms: Liver Diseases, acute viral hepatitis, elderly, hepatitis A, hepatitis B, hepatitis C

Features and Management of Primary Biliary Cirrhosis

 

Robert J. Fingerote, MD, MSc, FRCPC, Consultant in Gastroenterology and Internal Medicine, Queensway Carlton Hospital, Ottawa, ON.

Primary biliary cirrhosis (PBC) is a disease of unknown origin that causes chronic liver injury. It has an insidious onset, is associated with slow progression and ultimately leads to liver failure and either death or liver transplantation. It is presumed to be of autoimmune origin, is frequently associated with other autoimmune disorders and typically affects middle-aged and elderly women. Patients may be asymptomatic at diagnosis or present with typical symptoms of fatigue, pruritus and jaundice. Although current therapy may slow the progression of disease, no therapy has yet been proven to arrest or reverse the disease process.
Key words: cirrhosis, fatigue, autoimmune, cholestasis, antimitochondrial antibodies.

Related Terms: Liver Diseases, antimitochondrial antibodies, autoimmune, cholestasis, cirrhosis, fatigue

The Resilient Liver Deserves More Respect

The liver is seemingly an organ without any facility for "self promotion". Unlike the large bowel, it lacks an orifice that allows for early presentation of disease and dysfunction. Instead, like the kidney, a massive loss of function is required before symptoms of liver disease develop, and those symptoms are typically non-specific. Unlike the kidney, however, for which simple blood tests often give an indication of overall renal function, most so-called "liver function tests" do not measure function at all. This combination of factors results in liver disease often going undiagnosed until late in its course. In particular, infectious hepatitis can be contracted early in life, but may have its major deleterious effects only once the individual is much older.

The liver also gets little respect from geriatricians. We are continuously concerned about renal changes with aging and how to prescribe medications properly to accommodate those changes. However, the effects of an aging liver on drug disposition are less predictable, so we tend to ignore them, except in the presence of overt liver dysfunction. I certainly have had patients presenting with "drug-induced falls" who really had occult but severe liver disease with abnormal drug metabolism as the cause of their problems.

Hence, I think an issue with a focus on liver disease in the elderly is timely. From Drs. David Stell and William Wall, we have an excellent article in our Biology of Aging series on the impact of aging on the liver, which will help us understand the cumulative effects of aging on disease presentation. Dr. Robert Fingerote discusses primary biliary cirrhosis, another disease in which major, serious manifestations present after many years of disease progression. This issue presents articles on acute viral hepatitis by Dr. D'Arcy Little, portal hypertension and its complications in elderly patients with liver cirrhosis by Drs. Faisal Sanai and Cameron Ghent, and the diagnosis and management of gallstones in the elderly by Drs. Bao Tang and David Urbach. As the field of organ transplantation matures, an increasing number of elderly patients are being transplanted, and Drs. Douglas Thorburn and Paul Marotta review the indications and outcomes of liver transplantation in the elderly. To cap off this topic, our For Your Patient column comes from the Canadian Liver Foundation.

In other articles, Dr. Ron Keren discusses the relationships between alcohol and dementia, Drs. Ernane Reis and Nicholas Morrissey review the diagnosis of peripheral arterial disease in the elderly, Drs. Simpson and Ulanski II examine ocular malignancies, while Dr. Margda Wærn writes about physical illness and suicide. In a special article, one of Canada's most eminent and respected geriatricians and Program Director of the Regional Geriatric Program of Toronto, Professor Rory Fisher, reviews the implications of the Romanow Report for health care of the elderly.

Enjoy this issue.

Related Terms: Liver Diseases, liver disease
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